Provider Demographics
NPI:1578879144
Name:NORTHWEST PHARMACEUTICAL COMPOUNDING, INC
Entity Type:Organization
Organization Name:NORTHWEST PHARMACEUTICAL COMPOUNDING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEAD PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:425-385-2400
Mailing Address - Street 1:15407 MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7375
Mailing Address - Country:US
Mailing Address - Phone:425-385-2400
Mailing Address - Fax:425-385-3969
Practice Address - Street 1:15407 MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7375
Practice Address - Country:US
Practice Address - Phone:425-385-2400
Practice Address - Fax:425-385-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF60129620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPHAR.CF60129620OtherWASH STATE BOARD OF PHARMACY
WAFN2085240OtherDEA #